Effects of medical co‐morbidities on severe maternal morbidities in China: a multicenter clinic register study

Objective To investigate the incidence of severe maternal morbidities ( SMM ) in China and explore effects of medical co‐morbidities on SMM . Design Proactive multicenter clinic register collaboration. Setting Data on all deliveries at eight hospitals in Sichuan province, China, collected from 1 January 2009 to 12 December 2010. Population 33 993 delivering women and 34 547 live births. Methods We defined SMM as a combination indicator of severe maternal complications, critical interventions, admission to the intensive care unit and maternal near‐miss instances. We randomly selected 80% of the data from the entire database to build a logistic regression model. The remaining 20% were used to test the predictive power of the model. Main outcome measures SMM incidence, adjusted odds ratios ( aOR s), and area under a receiver operating characteristic ( ROC ) curve. Results Severe maternal morbidities incidence was 43.4/1000 live births [confidence interval ( CI ) 41.24–45.56]. Fifteen variables were independent contributors to the model. Seven medical co‐morbidities significantly affected the occurrence of SMM , including iron‐deficiency anemia ( aOR 3.07, CI 2.47–3.83) and other hematological diseases ( aOR 5.82, CI 3.50–9.69), hepatitis‐B virus infection ( aOR 1.48, CI 1.12–1.97) and other hepatic diseases ( aOR 3.81, CI 1.61–9.04), cardiopathy ( aOR 3.59, CI 2.62–4.93), hypertension ( aOR 5.23, CI 4.06–6.75), and respiratory diseases ( aOR 2.10, CI 1.25–3.52). The area under the ROC curve was 0.8127. Conclusions The incidence of SMM was typical of a low resource area. There is a need to identify medical co‐morbidities and to adopt prophylactic measures and interventions.